IRONICALLY enough, it was International Day to End Obstetric Fistula when it emerged that in Pakistan, the goal of ensuring that no more women fall victim to this debilitating medical condition, may become more elusive still. On Monday, the United Nations Population Fund announced that because of serious resource shortage, it can no longer continue supporting the fistula project in the country that has been running with its assistance since 2005. Thirteen centres have been set up at public-sector hospitals in major cities to provide free treatment for fistula, with training provided to doctors in handling such cases. According to the UNFPA, the memorandum of understanding signed with the Pakistan government was for only five years, following which the government was supposed to take over the project. That it has not done so is consistent with the low priority the state gives to maternal health.

Of the many terrible ways in which poverty and patriarchy together exact a toll on women, obstetric fistula is one of the most devastating. In Pakistan, around 5,000 women each year — inevitably from the poorest sections of society — develop the condition, in which internal injuries sustained during obstructed labour cause urinary or faecal incontinence to varying degrees. There are primarily two reasons for fistula to occur: early childbirth and/or delayed obstetric care. In the first, the misogynistic cultural practice of giving underage girls in marriage exposes them to the rigours of childbirth before they are physically mature. In the second, the state’s dereliction of duty in providing easily accessible, quality obstetric care renders even adult women at risk. Besides the physical ramifications, those who develop fistula also suffer far-reaching social and economic consequences. They are often spurned by their families and community, and have severely limited work opportunities. Poignantly enough, most cases of fistula can be repaired by a simple operation. All it takes is a government that has the will to tackle a problem that has no place in the modern world.

Published in Dawn, May 25th, 2016

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